Outcome of surgical treatment of perineal hernia in cats: 36 cases (2013-2019).

OBJECTIVES: To report the clinical presentation, complications, and long-term outcomes of cats treated for perineal hernia with modified internal obturator muscle transposition. METHODS: The medical records of cats surgically treated for perineal hernia between 2013 and 2019 were reviewed and an owner questionnaire was conducted to determine long-term outcome. RESULTS: Thirty-six cats were included in the study: 34 had bilateral and two unilateral hernias. Of these 36, 24 (67%) were male neutered with a median age of 10 (range: 1 to 18) years. The complication rate was low, however, one cat experienced a major postoperative complication: rectal prolapse requiring revision surgery 48 hours postsurgery. Short-term outcomes were available for 32 of 36 (89%) cats. Of the 32, 23 were examined 6 weeks postoperatively, and a telephonic consultation was performed for an additional nine of 32. Of the 23 cats examined directly, none had recurrence. Overall 12 of 32 experienced short-term postoperative tenesmus which resolved in nine of 12 (75%). Long-term outcomes were available for 31 of 36 cats (86%), with a median of 18.5 (6 to 89) months follow-up. A good outcome was achieved in 23 of 31 (74%) whereas three of 31 (10%) had fair outcomes and five of 31 (16%) had a poor outcome. Of the five cats with a poor outcome, two required subtotal colectomy to manage clinical signs related to megacolon, two were euthanised following a return of clinical signs, and one developed unilateral recurrence. CLINICAL SIGNIFICANCE: Perineal hernia should be considered in cats presenting with tenesmus or recurrent obstipation. Surgical treatment of perineal hernias in cats can result in good owner-assessed long-term outcome.

Feasibility of the single-incision subxiphoid approach for video-assisted thoracoscopic surgery in dogs.

OBJECTIVES: To report early results of uniportal video-assisted thoracoscopic surgery in dogs using a single-incision subxiphoid approach. MATERIALS AND METHODS: Retrospective study of 10 client-owned dogs with: pyothorax (n=5), pericardial effusion (n=2), bilateral pneumothorax (n=1), retained surgical swab (n=1), cranial mediastinal mass (n=1). With the dog in dorsal recumbency a 3-4 cm incision was made over the xiphoid process. After resection of the xiphoid process, a tunnel was created towards the pleura and open access maintained with an Alexis™ wound retractor. The pleural cavity was explored with a 10 mm 30° or 5 mm 0° telescope and straight laparoscopic instruments. RESULTS: Median surgical time was 75 minutes. The SISA technique was performed successfully in five of 10 cases and allowed easy and adequate inspection of the intra-thoracic structures. One case was converted to lateral thoracotomy after laceration of the vena cava and one converted to median sternotomy because of adhesions. An additional port was placed in three cases to facilitate triangulation and surgical manipulation. No other intra-operative complications were encountered. CLINICAL SIGNIFICANCE: In this initial report of uniportal thoracic approach in dogs, this technique allowed excellent access and treatment of mediastinal structures. Further cases are required to assess its suitability for pulmonary surgery.

Definition of new cut-offs of BMI and waist circumference based on body composition and insulin resistance: differences between children, adolescents and adults.

OBJECTIVE: This study aims to determine associations between anthropometric traits, regional fat depots and insulin resistance in children, adolescents and adults to define new cut-offs of body mass index (BMI) or waist circumference (WC). DESIGN: Cross-sectional data were assessed in 433 children, adolescents and adults (aged: 6-60 years, BMI: 23.6 [21.0-27.7] kg m-2). Total adipose tissue (TAT), regional subcutaneous adipose tissue (SATtotal, SATtrunk) and visceral adipose tissue (VAT) were determined by whole-body magnetic resonance imaging, fat mass by air-displacement plethysmography. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). Bivariate as well as partial correlations and regression analyses were used. Cut-off values of BMI and WC related to regional fat depots and HOMA-IR were analysed by receiver operating characteristics curve. RESULTS: In adults, TAT, SATtotal and SATtrunk increased linearly with increasing BMI and WC, whereas they followed a cubic function in children and adolescents with a steep increase at BMI and WC ≥1 standard deviation score and VAT at WC ≥2 standard deviation score. Sex differences were apparent in adults with women having higher masses of TAT and SAT and men having higher VAT. Using established BMI or WC cut-offs, correspondent masses of TAT, SATtotal, SATtrunk and VAT increased from childhood to adulthood. In all age groups, there were positive associations between BMI, WC, SATtrunk, VAT and HOMA-IR. When compared with normative cut-offs of BMI or WC, HOMA-IR-derived cut-offs of regional fat depots were lower in all age groups. CONCLUSIONS: Associations between BMI, WC and regional fat depots varied between children, adolescents, young and older adults. When compared with BMI-derived and WC-derived values, an insulin resistance-derived cut-off corresponded to lower masses of regional fat depots. Thus, established BMI and WC cut-offs are not appropriate to assess metabolic disturbances associated with obesity; therefore, new cut-offs of BMI and WC are needed for clinical practice.

Association between individual fat depots and cardio-metabolic traits in normal- and overweight children, adolescents and adults.

OBJECTIVES: To determine age-related associations between fat mass (FM), regional fat depots and cardiometabolic traits in normal- and overweight children, adolescents and adults. METHODS: Detailed body composition (regional subcutaneous and visceral adipose tissue; SAT, VAT) by whole-body magnetic resonance imaging (MRI), FM and fat-free mass by air-displacement plethysmography, systolic and diastolic blood pressure (SBP, DBP), triglycerides (TG), high-density lipoprotein cholesterol (HDL), plasma glucose and plasma insulin were measured in 433 subjects (BMI: 23.6 (21.0-27.7); 151 children and adolescents, aged 6-18 years, 150 young adults, aged 18-30 years and 132 adults, aged 30-60 years). Data were derived from pooled data of the 'Reference Center for Body Composition' in Kiel, Germany. Insulin resistance was determined by the homeostatic model assessment of insulin resistance (HOMA-IR). Partial correlations and multivariate linear regression analyses were used to evaluate the associations between body composition and cardiometabolic traits. A descriptive approach was used to demonstrate age-dependent differences in associations between body fat depots and insulin resistance, independent of BMI. RESULTS: FM, SAT, and VAT increased from childhood to adulthood with low VAT in children and adolescents. When compared to children, TG was higher in adults. HDL and DBP did not differ between age groups. Insulin resistance was highest in male adolescents and female young adults. Associations between body fat depots and cardiometabolic traits were seen after puberty with no associations in pre- and intrapubertal children. When compared to FM, SAT and VAT had the strongest association with insulin resistance in adults. This association was independent of BMI. CONCLUSIONS: Associations between individual body fat depots and most cardiometabolic traits became evident after puberty only. The strongest associations were observed between insulin resistance and abdominal fat in adults. The impact of VAT was independent of BMI.

Effects of the 1-amino-adamantanes at the MK-801-binding site of the NMDA-receptor-gated ion channel: a human postmortem brain study.

Recent studies from our laboratory have provided evidence that the 1-amino-adamantane derivative memantine (1-amino-3,5-dimethyl-adamantane) binds to the MK-801-binding site of the N-methyl-D-aspartate (NMDA)-receptor-gated ion channel. This action has been suggested to account for the antiparkinsonian and antispastic activity of the drug. In the present investigation we have extended our work by testing a series of 1-amino-adamantanes, including amantadine (1-amino-adamantane) and memantine, for their ability to compete with [3H]MK-801 binding in membrane homogenates of postmortem human frontal cortex. The most potent substance (1-amino-3,5-diethyl-adamantane) had a Ki-value of 0.19 +/- 0.06 microM while the weakest substance (1-N-methyl-amino-adamantane) had a Ki-value of 21.72 +/- 1.63 microM. The Ki-value of amantadine was 10.50 +/- 6.10 microM. In agreement with our earlier investigation, the Ki-value of memantine was 0.54 +/- 0.23 microM. The results indicate that 1-amino-adamantanes, in general, may produce their pharmacological effects through an interaction with the NMDA-receptor-gated ion channel. The displacement of [3H]MK-801 binding thus may provide the basis to predict the antiparkinsonian and antispastic activity of novel substituted 1-amino-adamantanes and possibly of other drugs.